Fungi types
1. Yeasts
2. Moulds
3. Dimorphic fungi
Yeast vs mold
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Candida
- Unicellular yeast
1. C. albicans
2. C. glabrata
3. C. krusei
Candida diagnosis
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Triazole Candida coverage
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Candidemia risk factors
1. TPN
2. Central venous catheter
3. Receipt of multiple antibiotics
4. Extensive burns/surgery
5. Mechanical vent
6. Immunosuppression
Candidemia S/S
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Candidemia treatment
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Thrush risk factors
1. HIV/immunocompromised
2. Neonates
3. Denture wearers
4. Use of ICS
Thrush treatment
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Esophageal candidiasis treatment
1. Fluconazole
2. Posaconazole or voriconazole
* 14-21 days
Vulvovaginal candidiasis treatment
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Fluconazole in pregnancy
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Candiduria treatment
- Remove urinary catheter
- Treat only if risk of dissemination
1. Patients who will undergo urological procedures
2. Neutropenic
* Fluconazole
Candida auris
- Can spread between patients in healthcare facilities & cause outbreaks
- Behaves like a resistant bacteria
- Can live on surfaces for months
- Echinocandicans 1st line
Dimorphic fungi
- Choose how they live
1. Blastomyces dermatitidis
2. Coccidiodes immitis
3. Histoplasma capsulatum
Histoplasmosis
- Dimorphic fungus
- Central US along Ohio & Mississippi River Valleys
- Takes 2-3 weeks to see change to yeast form
Histoplasmosis transmission
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Histoplasmosis severity
1. Acute
2. Chronic (opportunistic in pre-existing lung disease)
3. Disseminated (development of granulomas)
Histoplasmosis treatment
- Asymptomatic or mildly ill: no treatment
- Mild-mod: itraconazole
- Severe: amphotericin B for 1-2 weeks then itraconazole PO for 12 months
- Meningitis: amphotericin B for 4-6 weeks then itraconazole PO for 12 months
Histoplasmosis long-term suppressive therapy
1. CD4 < 150
2. Meningitis
3. Severe disseminated disease
* Itraconazole
Blastomycosis
- Dimorphic fungus
- Eastern US, near Great Lakes
- Culture can require 30 days
- Can see on KOH stain
Blastomycosis transmission
- Associated with decomposing organic matter (wood/leaves)
- Lives in moist soil
- Exists as mold in environment
- Inhaled as spores & transformed to yeast in host
Blastomycosis severity
1. Acute pulmonary
2. Chronic/subacute
3. Disseminated (CNS is rare, but deadly)
Asymptomatic blastomycosis treatment
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Mild-moderate blastomycosis treatment
- Pulmonary: itraconazole for 6-12 mos
- Disseminated: itraconazole 12 mos +
Mod-severe blastomycosis treatment
- Pulmonary: amphotericin B then itraconazole for 6-12 mos
- Disseminated: amphotericin B then itraconazole 12 mos +
Meningitis blastomycosis treatment
- Amphotericin B then azole 12 mos+
Coccidiomycosis
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Coccidiomycosis transmission
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Valley fever
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Coccidiomycosis treatment candidates
1. Immunocompromised
2. Pregnant
3. Concurrent diabetes
4. Frailty
5. Severe symptoms
Mild coccidiomycosis treatment
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Severe coccidiomycosis treatment
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Meningitis coccidiomycosis treatment
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Cryptococcosis
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Cryptococcal meningitis
- Amphotericin B + flucytosine for 2 weeks then 8-10 weeks of fluconazole
- Flucytosine rapidly sterilize CSF
Aspergillosis
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Aspergillosis allergy
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Aspergilloma
- Aspergillus fungus ball
- Neutropenia is common
- Surgical removal if > 500 mL
Aspergillosis treatment
- Voriconazole is DOC
- Treat until all s/s resolved (months-years)
Mucormycosis
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Mucormycosis transmission
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Mucormycosis presentation
1. Rhinocerebral disease
2. Necrotizing cutaneous mucormycosis
Mucormycosis treatment
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Amphotericin B monitoring
- Deoxycholate formulation associated with nephrotoxicity
- Hypokalemia, hypomagnesemia
- Preinfusion administration of 500 mL of NS with each dose
Azoles monitoring
- Posaconazole: requires high fat
- Voriconazole: visual disturbance
- Isavuconazonium: doesn't require food, hypokalemia, constipation